Scoping Review

A scoping review is a summary of the key concepts underlying an area of research, the main sources of information, and the types of literature and information available, and its purpose is to examine the breadth, scope, and nature of research activity (Arksey & O’Malley, 2005). The purpose of conducting the scoping review in this study is to provide a comprehensive overview of the wide range of findings on the current state of DMT in Japan.

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018) and adhered to the PRISMA-ScR Checklist.

Selection Criteria

In this study, the scoping review was conducted in stages, with additional investigations carried out based on the findings from the initial review. The first investigation was conducted from January 9, 2022, to February 9, 2022. Subsequent additional searches were performed from December 24 to 31, 2023, August 8 to 9, 2024, and February 28 to March 3, 2025.

The survey was conducted in both Japanese and English. The Japanese survey covered the period from 1992, when JADTA was established, to March 3, 2025, whereas the English survey covered the period from 1966, when ADTA was established, to March 3, 2025.

Searches were conducted using the Japanese search engines, such as Ichushi, CiNii, and Medical-Online, and the English search engines, including PubMed and Google Scholar. Predefined search terms were used for each database. The Japanese Journal of Dance Therapy and the American Journal of Dance Therapy were identified as major DMT journals.

The search key terms were combined as “dansu/mūbumento serapi” (dance/movement therapy) or “dansu serapi” (dance therapy) and “kainyu-kenkyu” (intervention study), “Jissen” (practice), or “Kouka-kenkyu” (effective study). To specify Japanese DMT in the search, the search key terms “Japanese dance/movement therapy” or “Japanese dance therapy” were used in the English search.

After removing 31 duplicate references from the initial screening, titles and abstracts were screened based on the acceptance criteria.

Literature extraction was verified multiple times by the authors, after which all the selected studies were carefully reviewed to evaluate the inclusion and exclusion criteria. If any disagreements arose during the screening process, the authors discussed and made a final decision. The selected Japanese studies were translated into English by the authors, and proofread by an English proofreader.

Inclusion and Exclusion Criteria

The inclusion criteria were as follows: original research articles published in academic journals in either Japanese or English in the period covered by the survey; using DMT interventions; using an intervention study design; texts including information that the DMT intervention was conducted in Japan, such as the fact that the participants were recruited in Japan or the description of the place of implementation of the DMT intervention in Japan.

The exclusion criteria were studies published in languages other than Japanese or English and articles published as meta-analyses, systematic reviews, narrative reviews, research notes, research and clinical reports, short and any other reports, special issues, theses, articles in books, and articles using interventions other than DMT. Studies using the DMT program as part of college or school coursework were excluded because the therapeutic effect of DMT was unknown. The introduction of the journal and the congratulatory addresses in the first issue were also excluded.

Levels of Evidence

The selected studies were evaluated to clarify their quality and evidence using LOE assessment tools developed by the Oxford Centre for Evidence-Based Medicine in 2011 (Centre for Evidence-Based Medicine, 2022).

LOE is designed to allow clinicians and patients to rapidly answer clinical questions and find feasible evidence (Center for Evidence-Based Medicine, 2022). It is structured into five levels, with level 1 indicating the highest quality of evidence and level 5 representing the lowest (Center for Evidence-Based Medicine, 2022).

Search Results

The initial search identified 672 studies and excluded 31 duplicates. The numbers of studies identified in each database were as follows: Ichushi, n=14; CiNii, n=35; Medical-Online, n=9; Google Scholar, n=15; PubMed, n=3. The results of additional records identified from other sources were as follows: Japanese Journal of Dance Therapy, n=81; American Journal of Dance Therapy, n=515.

During the first screening, the results were refined using specific key terms in the titles and abstracts of journals, eliminating 600 studies. Subsequently, during the full-text article assessment, the selected studies were reviewed to determine whether they satisfied the inclusion criteria.

A total of 63 studies were excluded from the analysis. The most common database search and additional search sources for the excluded studies were the Japanese Journal of Dance Therapy (n=32, 50.7%) and CiNii (n=19, 30.1%). The most common studies among the excluded studies were based on clinical reports (n=14, 27.4%), followed by special issues (n=13, 25.4%). Finally, nine studies satisfied the requirements (Arakawa, 2000; Ishikawa et al., 2014; Kaji et al., 2000; Kozuka & Chino, 2008; Shiba & Tanaka, 1993; Takahashi et al., 2020, 2022, 2023; Watanabe et al., 2011). The selected studies were analyzed during the final screening (Figure 1).

Figure 1 - Study flow diagram.

The selected studies were classified into 12 categories for data analysis: authors, years, study design, objects, participants (number of participants, sex, age or mean age±standard deviation, age range, and types of disease or disorder), session format (individual or group), methods (session duration, frequency, and number of sessions), interventions, elements of activities in the interventions, main outcome measures, results of the study, and conclusions (Table 1). The study design was classified following Tsushima (2017).

Characteristics of DMT Participants

Nine studies were selected, one of which involved two intervention studies (Kaji et al., 2000). In studies in which age was explicitly reported (n=8, 80.0%), participants’ ages ranged from 3 to 85 years. The mean ages of the most frequent participants were younger than 10 years (n=2, 25.0%), between 10 and 20 years (n=2, 25.0%), and older than 76 years (n=2, 25.0%).

The participants for DMT interventions were diagnosed with the following 24 diseases or disorders: Alzheimer disease, autism spectrum disorder with intellectual disability, avoidant personality disorder, borderline personality disorder, chronic pneumonia disease, dementia with Lewy bodies, dementia in head injury, dementia with a psychiatric disorder, depressive disorder, diabetes mellitus disease, Down syndrome with intellectual disability, eating disorder, frontotemporal dementia, intellectual disability, manic-depressive disorder, mixed dementia of Alzheimer and vascular, osteoporosis of the spine, Parkinson disease, Parkinson disease with dementia, personality disorder, schizophrenia spectrum disorder, sequelae of brain disease, vascular dementia, and Williams syndrome with intellectual disability. Healthy individuals participated in the DMT intervention study.

The total number of DMT intervention participants was 169, of whom 99 (58.5%) had some type of disease or disorder. Seventy (41.4%) participants were healthy.

The most common disease or disorder for DMT interventions in Japan was intellectual disability in four studies (44.4%), with a total of 42 participants (24.8%). Among the 42 participants with intellectual disability, one had autism spectrum disorder (2.3%), 16 had Down syndrome (38.0%), and four had Williams syndrome (9.5%). Other DMT participants were individuals with intellectual disability with no other complications (n=21, 50.0%). The second most common disease or disorder was schizophrenia spectrum disorder, which was observed in two studies (22.2%) with a total of 16 participants (16.1%).

Characteristics of Outcome Measures

Thirty-seven outcome measures were conducted, of which the most common were the Child Behavior Checklist (n=3, 8.1%), observing movements through recorded videos (n=3, 8.1%), and Timed Up and Go (n=3, 8.1%). The same researchers (Takahashi et al., 2020, 2022, 2023) used the Child Behavior Checklist and Timed Up and Go in separate studies.

The next most common outcome measures were Caregiver–Teacher Report Form (n=2, 5.4%), Draw-a-Person method (n=2, 5.4%), hand-held dynamometer (n=2, 5.4%), Jikoninchi-Shakudo (Self-Cognitive Scale) (n=2, 5.4%), posturography (n=2, 5.4%), Shintaizou-Shakudo (Body Image Scale) (n=2, 5.4%), and Wechsler Intelligence Scale (n=2, 5.4%). The Caregiver–Teacher Report Form (Takahashi et al., 2022, 2023), hand-held dynamometer, posturography, and Wechsler Intelligence Scale (Takahashi et al., 2020, 2022) were used by the same researcher in separate studies. The Jikoninchi-Shakudo (Self-Cognitive Scale) and Shintaizou-Shakudo (Body Image Scale) were used by the same researcher (Kaji et al., 2000) to evaluate the two interventions in one study.

Of the 37 outcome measures, only 13 (35.1%) were standardized or objective. Of these, six (16.2%) were standardized assessments, including the following: The Achenbach System of Empirically Based Assessment, including an Adult Behavior Checklist for Adults and the Elderly, Child Behavior Checklist for Young and School-Age Children, and Teacher Report Form for Young and School-Age Children (Achenbach, 2015), which are checklists that provide evidence-based assessments that assess the participants’ adaptive function and behavioral, emotional, and social problems (Achenbach, 2015); Brief Psychiatric Rating Scale for assessing the participants’ psychiatric symptoms such as depression, anxiety, and unusual behavior (Overall & Gorham, 1962); Mini-Mental State Examination for quantitatively estimating the degree of cognitive impairment and continuously documenting the changes in cognitive function (Molloy et al., 1991; Tombaugh & Mclntyre, 1992); Neuropsychiatric Inventory for assessing the participants’ behavioral psychological symptoms of dementia (Kaufer et al., 1998); Psychogeriatric Assessment Scale used for assessing the clinical changes seen in dementia and depression (Jorm et al., 1997); Wechsler Intelligence Scale for assessing the participants’ intelligence quotient (Keith et al., 2006; Tulsky et al., 2001).

Seven studies (18.9%) used objective measures, including hand-held dynamometer for assessing the participants’ muscle strengths (Stark et al., 2011); heart rate reserve for assessing the participants’ percentage of heart rates (Swain & Leutholtz, 1997); Kan’igata Amylase Sokuteiki (salivary amylase activity monitor) for assessing the participants’ salivary amylase activity levels (Yamaguchi et al., 2004); Nihon Kouden Nouhakei EEG-9100 (electroencephalography) for assessing the participants’ electroencephalograms (Çabalar et al., 2011); physiological indicator of the saliva levels for assessing the participants’ stress-related hormones cortisol and chromogranin A (Noto et al., 2005); posturography for assessing the participants’ balance and postural abilities (Visser et al., 2008); Timed Up and Go for assessing participants’ dynamic balance of lower extremity functions and mobilities (Podsiadlo & Richardson, 1991).

Characteristics of DMT Sessions

Most DMT interventions were conducted in group sessions (n=9, 90.0%), with only one (10.0%) conducted in individual sessions.

The intervention duration ranged from 30 to 60 minutes, with the most common intervention duration being 60 minutes (n=5, 50.0%). This was followed by 45 minutes, including 45 to 60 minutes (n=3, 30.0%).

The most frequent intervention frequency was once a week (n=5, 50.0%), followed by once every 2 weeks (n=2, 20.0%). Three (30.0%) studies did not report the intervention frequency.

The most frequent number of DMT intervention sessions was 10 (n=5, 50.0%), followed by less than 10 (n=2, 20.0%). Two studies (20.0%) did not report the intervention frequency.

Characteristics of Interventions (Elements of Activities)

The most common intervention method was a warm-up or introduction, development, and closing structure (n=5, 50.0%). Four studies (40.0%) did not report the structure of DMT interventions.

A total of 47 elements of activities were included in the DMT intervention. The most common elements of the activities in the DMT interventions were mirroring (n=5, 10.6%) and touching, including holding hands (n=5, 10.6%). The second most common element was authentic movement (n=4, 8.5%), and some types of dance (n=4, 8.5%) were also conducted. The next most common activities were the use of props (n=3, 6.3%) and expressing images (n=3, 6.3%) as movements.

Results of the Studies (Conclusion): Effects of DMT Interventions

There were 23 reports on the effectiveness of DMT interventions. The most common effects were improved balance (n=3, 13.0%; static balance, n=2; dynamic balance, n=1) and positive expression (n=3, 13.0%). The next most common effects were a decrease in attention and affective behaviors (n=2, 8.6%) and an improvement in body image (n=2, 8.6%), empathy (n=2, 8.6%), and self-cognition (n=2, 8.6%).

Results of Quality and LOE of DMT Intervention Studies

This study demonstrated that nine intervention studies were conducted from 1993 to 2024, and four studies (44.4%) were conducted in the past decade.

Regarding LOE, two studies (22.2%) were at level 2, three (33.3%) were at level 3, and four (44.4%) were at level 4. The study designs of level 2 of LOE were randomized controlled trials (RCTs) (n=2, 22.2%), whereas those of level 3 of LOE were before–after trials (n=2, 22.2%) and controlled clinical trials without RCTs (n=1, 11.1%). Level 4 of LOE were case study (n=1, 11.1%) and case series (n=3, 33.3%) (Table 2).

LOE, levels of evidence; RCTs, randomized controlled trials.

Six (67.0%) of the nine intervention studies were based on study designs without control groups, such as a case study, and case series studies, and before–after trials.

Characteristics of Participants

In this study’s results, 99 of 169 DMT participants had some type of disease or disorder, and the participants’ diseases or disorders were diagnosed in 24 categories. The most common disease or disorder in DMT intervention studies in Japan was intellectual disability (n=42, 24.8%).

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (American Psychiatric Association, 2022), intellectual disability is defined as “a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains” (p. 37). Additionally, individuals with intellectual disability have defective motor function (Wuang et al., 2018).

DMT is expected to have a therapeutic effect on both intellectual and adaptive dysfunctions, which are characteristics of individuals with intellectual disability. Non-verbal physical communication interventions through DMT are characterized by their ability to intervene without language for individuals with intellectual disability. Thus, a unique feature of this intervention is that by implementing a non-verbal intervention, the intervention can be implemented even when the intellectual functioning of language skills is impaired (Takahashi et al., 2023).

In addition, mirroring or synchronizing movement interventions may enable individuals with intellectual disability to imitate or synchronize their movements with a therapist or the participants’ rhythm of movements in a DMT session, enabling them to learn appropriate behaviors in response to the situation (Takahashi et al., 2022). This may lead to decreased adaptive dysfunction.

Characteristics of Outcome Measures

In this study, only 13 (35.1%) of 37 outcome measures were standardized (n=6, 16.2%) and objective (n=7, 18.9%). Most DMT intervention studies in Japan used highly subjective outcome measures. This may be because, except for dance/movement therapists affiliated with universities and research institutions, numerous research practitioners have few opportunities to learn objective study methods. Additionally, these research implementers have limited opportunities to obtain research grants, making it difficult for them to purchase standardized outcome measures and objective measurement instruments.

However, the implementation of objective study methods is necessary to develop Japanese DMT. To conduct objective studies, regular study sessions between clinicians and researchers in each therapist’s area of expertise will deepen knowledge of studies and enable objective intervention studies. Additionally, conducting collaborative studies between clinicians and researchers or with other professionals may lead to the acquisition of research grants.

Characteristics of DMT Interventions (Elements of Activities)

The results indicated that the most common interventions were structuralized interventions (n=5, 50.0%), such as warm-up or introduction, development, and closing structure.

Marian Chace, the pioneer of DMT, created a structure of interventions that incorporated dance and movement as its prime communication and expression through three structures: warm-up (introduction), theme development (development), and closure (Levy, 2005). The purpose of each intervention was as follows (Levy, 2005): warm-up (introduction) aims to connect and communicate with participants during initial contact; theme development (development) aims to pick up, process, and reflect on participants’ thoughts, feelings, and ideas both verbally and non-verbally; closure aims to emphasize with participants a sense of release and satisfaction.

Most interventions (n=5, 50.0%) used the above structuralized interventions to achieve their objective. The implementation of structuralized intervention allows for the replication of studies. In addition, in a clinical setting, structuralized intervention is important to replicate the effectiveness of DMT intervention. Replicating the efficacy of DMT will enable its establishment as an effective therapy.

However, four interventions (40.0%) did not report any intervention methods. The description of the intervention is important to clarify its effects and should be described in future studies.

The most common elements of these activities were mirroring (n=5, 10.6%) and touching, including holding hands (n=5, 10.6%). When mirroring is used in conjunction with music as an intervention, the participants and therapist can link their movements, and through repeated imitation of the movements, improvements in balance abilities have been reported (Takahashi et al., 2020, 2023). Regarding touching, there have been no reports on specific procedures for utilizing touching in DMT interventions or their effects. Therefore, future studies should examine specific procedures for touching DMT interventions in Japan and their effectiveness in objective touching. Moreover, by demonstrating the specific use of touch, the characteristics of the DMT and its novel benefits in Japanese culture may become clear.

Results of the Studies (Conclusion): Effects of DMT Interventions

In this study, the most common effects were improved balance (n=3, 13.0%; static balance, n=2; dynamic balance, n=1) and positive expression (n=3, 13.0%). These effects suggest that DMT interventions in Japan can improve physical performance, improving the dynamic and static balance necessary for postural adjustment. The most frequent participants in DMT in Japan were individuals with intellectual disability, and the characteristic comorbidity was motor dysfunction. The study results may have been influenced by numerous reports indicating that DMT interventions have reduced motor dysfunction in the daily lives of individuals with intellectual disability.

In addition, through the DMT intervention in Japan, there was a mental improvement in positive expressions, which is necessary to maintain quality of life in daily life. Japanese DMT has therapeutic effects on both physical and mental health.

Quality and LOE of DMT Intervention Studies

The study results indicated that only two studies used RCT designs, and six were based on study designs without control groups, such as a case study, and case series studies, and before–after trials. Moreover, there were only two DMT intervention studies at level 2, three at level 3, and four at level 4. Based on these results, we found that levels of evidence in DMT intervention studies in Japan tended to be low.

The reasons for this are as follows. The DMT is characterized by reading participants’ thoughts and actions based on their facial expressions, communication, and physical expressions through movement and dance. It also includes selecting music, dances, and physical movements based on their characteristics. Although this allows therapists to read the changes in each participant and implement interventions tailored to each participant, it may be related to the difficulty of conducting an objective study design, such as RCTs. However, it is critical to provide a scientific rationale for DMT intervention studies to enhance the value of DMT in medical facilities, welfare areas, and educational facilities as therapeutic treatment, and an improved study design is essential.

For Future Studies

First, this study primarily focuses on DMT intervention studies conducted in Japan but also serves as a valuable reference for advancing scientific research and improving the quality of DMT protocols in intervention studies across other Asian countries with similar cultural elements and practices. By thoroughly analyzing the characteristics of DMT interventions in Japan, such as participants, intervention methods, treatment effects, and the quality of intervention studies, the DMT interventions that can be applied to other Asian countries are revealed. The results and data of this study may serve as a valuable reference for countries with similar cultural elements, providing specific guidelines and frameworks to enhance the quality of DMT protocols.

Second, although there are references introducing DMT practices in Asian countries such as China, Korea, Japan, Hong Kong, India, and Vietnam (Zhou et al, 2019), there has been no systematic review using objective research methods with high reliability and validity, such as Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Consequently, the current status and quality of DMT intervention studies in these Asian countries remain unclear. Using this study as a reference to investigate the status of DMT intervention studies in Asian countries may clarify its effectiveness and challenges. Moreover, future research should compare Japanese DMT practices with those in other Asian countries to highlight distinctive features and understand their significance from an international perspective. This comparative approach could lead to improved protocols and a more nuanced understanding of DMT’s impact and effectiveness in diverse cultural contexts.

Third, we recommend that RCTs improve the quality of DMT intervention studies in Japan. In addition, we believe that the use of the Consolidated Standards of Reporting Trial (CONSORT) statement when conducting RCTs will ensure study quality. The CONSORT statement, comprising a 25-item checklist and flowchart, is an internationally established set of integrated standards for the reporting of clinical trials, aimed at improving the reporting of RCTs, helping readers understand the conduct of clinical trials, and evaluating the validity of trial results (Moher et al., 2010). Moreover, the use of standardized or objective outcome measures is essential to demonstrate the effectiveness of treatments based on scientific evidence.

Fourth, this study only represents the current status of DMT intervention studies in Japan; as the number of intervention studies increases, the characteristics of DMT in Japan may change. Therefore, further investigation will be necessary after several years.

Limitations

The first limitation is that very few DMT intervention studies are conducted in Japan, and the number of DMT intervention studies in Japan is limited. Among the excluded studies, the most common Japanese DMT studies were clinical reports (n=14; 27.4%). There have been some clinical reports on the current status of DMT intervention studies in Japan; however, these have not led to intervention studies. This may be because the Japanese DMT has not been defined, and specific treatments, such as intervention methods and therapeutic effects, may not be clear. Consequently, it is possible that the location of the study may be limited or that participants in intervention studies may not have been recruited. Although the number of selected studies was limited, this report is crucial for understanding the current state of DMT intervention studies in Japan.

Second, three selected studies (Takahashi et al., 2020, 2022, 2023) were authored by one of the authors of this study, which may have led to bias toward the results of this study. In addition, one study (Kaji et al., 2000) used two interventions and the same outcome measures for the two interventions, which may have biased the results of this study.